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Extracorporeal Circulation During Lung Transplantation Procedures: A Meta-Analysis
Dominik J Hoechter1, Yu-Ming Shen, Tobias Kammerer
1From the *Department of Anesthesiology, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany; †Institute of Medical Biometry and Epidemiology, Ludwig-Maximilians-University (LMU), Munich, Germany; ‡Clinic of Cardiac Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany; §Transplantation Center, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany; and ¶Department of General, Visceral, Transplant, Vascular and Thoracic Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.
Extracorporeal membrane oxygenation (ECMO) may offer benefits over cardiopulmonary bypass (CPB) in lung transplantation, particularly reducing intensive care unit (ICU) stays. However, larger trials are needed to confirm ECMO
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Extracorporeal circulation (ECC) is vital in lung transplantation (lutx).
- A shift from cardiopulmonary bypass (CPB) to extracorporeal membrane oxygenation (ECMO) for intraoperative ECC in lutx is occurring, with varied outcomes.
- Evidence comparing ECMO and CPB in lutx requires systematic review.
Purpose of the Study:
- To conduct a meta-analysis comparing intraoperative veno-arterial ECMO (VA-ECMO) with CPB in lung transplantation.
- To evaluate the impact of ECMO versus CPB on blood transfusions, ventilator support duration, ICU length of stay, and mortality.
- To identify factors influencing outcomes through meta-regression.
Main Methods:
- Systematic literature search of Medline, Embase, and PubMed.
- Independent study selection and bias assessment using the Cochrane collaboration's ACROBAT-NRSI tool.
- Meta-analysis and meta-regression of six observational studies comparing VA-ECMO and CPB in lutx.
Main Results:
- A trend towards reduced blood product usage (RBCs, FFP, platelets) with ECMO was observed, but not statistically significant.
- Ventilator support duration showed a non-significant trend towards reduction with ECMO.
- ICU length of stay was significantly shorter in patients undergoing ECMO compared to CPB (MD -4.79 days).
- ECMO showed a non-significant trend towards improved 3-month and 1-year mortality.
- Meta-regression indicated heterogeneity influenced by patient sex, year of ECMO implementation, and underlying disease.
Conclusions:
- Intraoperative ECMO may provide short-term benefits in lung transplantation, notably reducing ICU length of stay compared to CPB.
- No statistically significant differences were found in blood transfusion requirements or long-term outcomes.
- Further multi-center randomized trials are necessary to definitively establish the superiority of ECMO in lung transplantation.
